Pelvic exercises ease urinary incontinence in women

Pelvic floor muscle training is effective for treating adult women with urinary incontinence without risk of side effects, according to a new report from the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services.

The report also found that drug-based treatments can be effective, but the degree of benefit is low and side effects are common.

"Urinary incontinence can affect women in a variety of ways, including physically, psychologically and socially — and some of these impacts can be severe," AHRQ Director Carolyn M. Clancy, MD, said in a news release. "This new report will help women and their clinicians work together to find the best treatment option based on each patient’s individual circumstances."

Urinary incontinence affects approximately 25% of young women, up to 57% of middle-aged and postmenopausal women and approximately 75% of older women in nursing homes, according to information in the study. The condition can impose significant, potentially debilitating lifestyle restrictions.

The cost of incontinence care in the United States averaged $19.5 billion in 2004, and by one estimate the average annual cost of women’s nursing home admissions from urinary incontinence was $3 billion. Among nursing home admissions of older women, 6% were attributable to urinary incontinence.

Researchers concentrated on two kinds of incontinence: stress incontinence, or the inability to retain urine during coughing or sneezing; and urgency incontinence, an involuntary loss of urine associated with the sensation of a sudden, compelling urge to urinate. Both types usually occur when the urinary sphincter fails, often as a result of weak pelvic floor muscles.

Exercises to strengthen the pelvic floor muscles, similar to Kegel exercises, were found to be effective in increasing women’s ability to hold their urine. Pelvic floor muscle training combined with bladder training improved mixed (both stress and urgency) incontinence, the report found.

Estrogen treatment was found to be effective in treating stress incontinence, but with some side effects. Another drug treatment, the antidepressant duloxetine, was not found to be effective and carried a high risk of side effects.

With some drugs, women were more likely to discontinue treatment because of bothersome side effects. The report provides comprehensive information about side effects of each drug to help clinicians and patients choose treatments with the most benefits and least harms.

The researchers noted that despite ample evidence on clinical measures for treatment of urinary incontinence, such as grams of urine lost, there are relatively few measures of quality of life related to the condition and its treatments.

The report, a comparative effectiveness review prepared for AHRQ’s Effective Health Care Program by the Minnesota Evidence-based Practice Center, was published in the April 9 issue of the Annals of Internal Medicine. The full report and summary publications for consumers and clinicians are available at www.effectivehealthcare.ahrq.gov.